Nora Becker – The ACA, Women’s Health, and Contraception (Podcast #5)

Though Nora is now officially Dr. Becker, and has begun her internship at Brigham and Women’s, I had the opportunity to sit down with her while she was still a student at Penn. We had a great conversation about her research, which focused on the Affordable Care Act’s impact on women’s health. We went more in depth on a specific project looking into the ACA’s effect on women’s overall contraceptive usage.  This work was tweeted out by then President Barack Obama, which led to a media frenzy, and almost immediately made her work political.

Nora received her bachelors in Public Policy from Pomona College in 2007. Before going to Penn for med school, she deferred a year to work as a staffer on Barack Obama’s presidential campaign, and as an administrative assistant in the White House.

Some major takeaways from our conversation:

1.) Though uncommon, you can do your MD/PhD in something outside of basic science

When I think of MD/PhDs, I immediately assume the person is doing biomedical research. However, it is definitely possible (at some schools) to do your PhD in many other fields! As you will probably want to have it relate back to healthcare, healthcare economics is an increasingly important field for future physicians to appreciate! There are plenty of other ways to delve into that world without dedicating 3-4 extra years of research – such as a master’s degree, certificate, or by getting involved with a specific research project. But if you are really drawn to the field, the PhD is an option!

2.) Research gives you the rare opportunity to be genuinely ambivalent

I loved Nora’s attitude when she said that if the ACA was repealed, she would study the effects of it being repealed. I personally had been interested in studying and working in health policy, but the 2016 election really made me question whether to get involved or not. It had less to do with politics as much as my realization of the transient nature of policy, the high failure rate in passing legislation, and that by picking a side, half the country will immediately decide that you are wrong. Perhaps it’s a cynical view, but I would have expected that Nora would have been terrified that her research, which she spent years on, would become essentially irrelevant if the ACA were to be repealed.

Instead, Nora maintained her positivity and insisted she would adapt. Though she also works in advocacy and has policies she would like to see implemented, when it comes to research, there will always be questions to pose and answers to discover. This is the benefit of being a researcher, I suppose. If you’re on the sidelines, you have the benefit of studying something regardless of what happens in policy. If you only work trying to get specific legislation passed, or in advocacy for specific cause, you are far more likely to be disappointed, or feel like you aren’t making progress. Combining research with advocacy may be best for your overall sanity and morale. This in mind, it’s impossible to be unbiased and have no opinions on health policy matters, but as a researcher you are (hopefully) able to put those feelings aside, and search for the truth. However…

3.) Explaining complex research to the public and media outlets can be frustrating, especially when it becomes politicized

Nora was both blessed and cursed when President Obama tweeted out her research. While it is incredible to see people take an interest in your work, it can be equally frustrating to watch as people either misinterpret it, or use it for their own political messaging. Sometimes this can’t be avoided – media coverage usually necessitates explanations for the layman. Yet, so much can be lost in translation when you simplify the language of your work, or distill it down to 500 words. After all, you can’t sit down with every reader and talk them through your paper, and the complicated economic analyses you performed. This is true for most research, but especially for biomedical research – media outlets LOVE blowing findings out of proportion. That’s why we need websites like – to keep a leash on irresponsible healthcare reporting.

The best we can do if we are fortunate enough that our work draws widespread attention is to control our own messaging, but understand that some things are simply out of our control.


You can find some of Nora’s work listed on PubMed here.

I’m excited to find out what Nora researches next – there are some whispers of looking into opioid usage. We’ll just have to wait and see!


– Ryan is a second year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, the co-host of the Penn Health-X podcast, and founder/editor-in-chief of the Penn Health-X blog. You can contact him at ryan.o’ –

Dr. Debbie Kelly – Leaving Clinical Practice for Industry (Podcast #4)

Ryan O’Keefe, MS2

It was great to speak with Dr. Kelly more in-depth, after she came to speak for the Health-X seminar series. Before I jump into the major takeaways from our discussion, a quick background.

In medical school at Columbia, Dr. Kelly was choosing between orthopedics, endocrinology, and ophthalmology. After a rotation, she chose ophthalmology and did her residency in Atlanta. She then came to Penn where she jumped back and forth in a number of roles within the Penn network of hospitals. After 11 and a half years of practice, Dr. Kelly was put in touch with someone at GlaxoSmithKline who showed her all of the opportunities in pharma for those with an MD. She joined the company to help work on an ophthalmology drug which ended up not panning out. She then moved to the pharmacovigilance department at GSK where she was able to work on more than just ophthalmology drugs. Last year, she was contacted by a headhunter and was recruited to lead to pharmacovigilance department at Spark Therapeutics, where she is today.


I was struck by few things during our conversation.

1.) It’s not uncommon to be torn between many specialties, and in actuality, many doctors would be happy doing many different things!

From the vantage point of a first-year medical student, it was a breath of fresh air to know that many people have trouble narrowing down their choice of what residency to do. At places like Penn where we are fortunate enough to learn from those leading their respective fields, it can feel like all of the attendings and PI’s had a single calling which they knew of from birth. It’s hard to imagine rock stars like Carl June not knowing he wanted to go into immunotherapy research, and yet there was certainly a time and place where I’m sure that was a tough decision.

A generalist at heart, it’s tough to accept that I would probably be happy practicing many different types of medicine. Sometimes the medical training pipeline can make it seem like there is only one perfect fit for you, and it’s on your shoulders to find out which. Yet, the I reject the idea that I will find the perfect clinical match. In fact, we would do well to think of Dr. Kelly and how she chose ophthalmology not because it was the only thing she could ever see her doing, but because it felt right. While she was able to bring her expertise as an ophthalmologist to both GSK and Spark, she has had to develop many new skills, and continue to learn. Flexibility, and the ability to pick up new knowledge quickly are skills that will transfer well into any endeavor you take on. Be an expert, but don’t lose your adaptability.

2.) Those who choose to ultimately pursue opportunities outside of clinical practice may still really enjoy working with patients!

I’ve noticed there is a stigma that people who end up leaving clinical practice either don’t care about patients, or secretly (or not-so-secretly) disliked clinical practice. While this is undoubtedly true for some people, after talking with Dr. Kelly, it became clear that some leave clinical practice because they are ready to take on different challenges. Furthermore, if they end up working in other sectors of the healthcare space, they are able to bring a clinician’s perspective, and advocate on behalf of the patient experience. Dr. Kelly was drawn to GSK in part because she could improve the standard of care for many more patients by helping to develop an effective drug. Whether you are directly or indirectly benefiting the care of patients, you are an important part of the drug supply chain.

3.) All the flashy scandals aside, industry isn’t by default the “Dark Side”

I think Dr. Kelly put it best when she said that there are good and bad people who act accordingly in all facets of life. Are there selfish actors in the drug development world? Of course. But is the research community, or the clinical world only full of angels working solely for the greater good? No way – they just don’t have as much publicity and capital at stake.

It’s easy to point fingers and create simplistic bad guys in our minds when we think about the monster that is the U.S healthcare system. The gene therapies at Spark, where Dr. Kelly currently works, will undoubtedly cost tons of money – maybe even close to (or above) a million dollars. Yet they are potentially curative, one-time therapies for diseases with either no standard of care, or treatments that significantly reduce the patient’s quality of life. Even if you believe that the insurance industry or pharmaceutical companies are evil, money-hungry corporations, shouldn’t we want people like Dr. Kelly taking her experiences and passion for patient care into the conversation? Maybe you could be the voice for both doctors and patients at such companies, changing the discussion from the inside. With MD’s on the sidelines, I wouldn’t expect much to change on its own. Things are far from black or white, and I always try to remind myself when I frame problems within the system as having good guys and bad guys.

4.) Hopping off the clinical train can be tough, but you have to make sure you’re staying on for the right reasons

When deciding whether or not to pursue a new opportunity, or continue along on the path laid out before you, Dr. Kelly insists we must be critically self-reflective and determine whether we are afraid to make a change simply because of inertia. Pursuing opportunities and projects – especially those in the H-MET space, like starting a company, consulting, or working in hospital administration – often lead clinicians to leave practice, or only see patients part-time. This can be a harrowing decision, especially because after a number of years, clinical practice can be so comfortable in terms of income and lifestyle. It’s not always easy to determine whether we are scared to do something because of inertia, or because it’s a genuinely poor choice.

Dr. Kelly shared that she knew it was time to make a change when she couldn’t wait to tell her friends and family about the opportunity to work at GSK. Sometimes it’s something you just know. Other people will need to do an elaborate cost-benefit analysis and have long conversations with people who know them best before they decide to make a change. However it is you approach making tough decisions, be wary of turning down opportunities out of fear. You may look back and regret it.

– Ryan is a second year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, the co-host of the Penn Health-X podcast, and founder/editor-in-chief of the Penn Health-X blog. You can contact him at ryan.o’ –

Ryan Littman-Quinn – mHealth and the Botswana-UPenn Partnership (Podcast #3)

– Ryan O’Keefe, MS2 – 

My discussion with Ryan Littman-Quinn closely followed my conversation with Dr. Kovarik. The two have worked together on many projects, and yet I was able to take away many different lessons from this discussion.

First, a quick background on Ryan. He went to Boston College for undergrad where he studied business with a minor in philosophy. He found himself interested in advertising and marketing. Not wanting to go down a path already traversed, he turned down traditional marketing positions and reached out to the start-up Click Diagnostics, and was able to convince them that he could help them with their logo design, among other marketing tasks.

From there, he was able to pivot to global health work within the company, and took a risk by moving to Africa to learn more about mHealth. His early work and the lessons he learned helped make him one of the go-to mHealth experts in global health, leading him to work with the Botswana-UPenn partnership. Currently, he is able to balance this work with another company, Peak Vision, which is leveraging mHealth software and hardware to bring much needed vision care to underserved communities.

Some of the major takeaways:

1.) You need to make clear the value you will bring to a company or project

It’s not unusual for someone to cold call trying to get a job. What’s rare, though, is actually landing that job. Ryan was able to successfully impress Click Diagnostics because he was able to demonstrate his value and skills by framing them in terms of what Click Diagnostics needed. Dale Carnegie in his famous book “How to Win Friends and Influence People”  says that you must “talk in terms of the other person’s interest.” It shows guts and that you’ve taken an interest in the company by knowing what they are currently doing well, and how they can improve.

2.)It takes luck and good timing to be an expert in an up-and-coming field, but also hard work, and some risks

Though Ryan’s skills were mostly in marketing, he was given a rare opportunity to go abroad and develop a newer skill set. It would have been easy for him to stick with what he knew, but he saw that mHealth was a new and exciting field that he wanted to learn more about. It helps that he was young and free to travel without feeling tied down to any one place. Once you’re on the medical path – either in school or residency, it may seem impossible to pick up and try something completely new like this. I fervently disagree!

Med school is probably the very best time to go abroad or learn a new skill set. It may feel like your days are too busy, but if you pursue clinical practice, they certainly won’t free up any time soon. Also keep in mind that opportunities will often come your way once you become established – but taking a chance on something new isn’t always easy. Check out the episode with Dr. Debbie Kelly  for another great example of this. I’m sure when Ryan first googled Botswana and told himself he could make it there, he didn’t foresee himself becoming the “mHealth guy”. Yet here he is.

3.) Being in expert in a field will bring with it lots of great opportunities, but also a lot of “unsexy” work

It’s a fallacy we all fall for – detectives on Law and Order solve intriguing murder cases, doctors on Grey’s Anatomy average 3 saved-lives per hour, Dr. House gets to tackle the most challenging medical mysteries the human body has ever presented. Further, it’s easy to believe that by working with Peak Vision and the Botswana-UPenn partnership, Ryan’s days are full of meaningful patient interactions, and he can hit the pillow at night, knowing he has brought vision to thousands of people in need.

While the job can certainly be fulfilling, it’s important to always remember to pull back the curtain and see the “unsexy” side of things. Developing and overseeing mHealth projects includes a lot of planning, desk work, emails, and inevitable crisis management when your mobile devices bum-out on launch-day.  It’s a good lesson for any line of work – especially clinical practice. You may have heard the sentiment that you need to be able to handle the monotony of any clinical field, because that’s what you’ll likely be dealing with most of your time. It’s no different for every other type of job.

4.) A medical education is a launching point, but it certainly can’t prepare you for everything

One of the many reasons why we wanted to start Penn Health-X, the podcast, and this blog is that while medical education prepares us to be excellent researchers and clinicians – and more recently how to work on teams and be humane healers – it doesn’t teach us business skills, principles of management, and about various cultures across the globe. Ryan insisted that no matter how much you learn in the classroom, you will never be fully ready to start an mHealth project in an unfamiliar country.

Though this can be unsettling, the beauty is that you learn on the job. Only through putting yourself out there and jumping with both feet can you grow and develop particular skill sets. Learning in the classroom is crucial for laying a foundation of knowledge, but I am especially guilty of using it as a crutch – after all, it’ comfortable to sit in a lecture room and digest material at your own pace, and far more uneasy to be grilled by an attending in the wards, and having to talk to patients face to face. Yet the clinical year, and the first year of residency are unanimously considered the years where you truly start to become a doctor and not just a roided-up biology major. The value in ideas and knowledge is in using them (thanks Thomas Edison, probably..) – so get out there and show us what you’ve got!

– Ryan is a second year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, the co-host of the Penn Health-X podcast, and founder/editor-in-chief of the Penn Health-X blog. You can contact him at ryan.o’ –

Dr. Kovarik – Teledermatology (Podcast #2)

– Ryan O’Keefe, MS1 –

I had the privilege of sitting down with Dr. Kovarik to discuss her career, and how she became a leader in the field of teledermatology. Dr. Kovarik grew up in Texas and studied electrical engineering at Texas A+M. Having worked for a number of years at AT+T before moving on to medicine, she was uniquely positioned to apply her understanding of the communications world to medicine. Dr. Kovarik was drawn to pathology and dermatology because they were visual-focused fields. She has been in medicine for 11 years now, and has used her wide-ranging skills to apply telecommunications technology to underserved populations, most notably those in Africa.

Some of the major takeaways from our discussion:

1.) You can leverage your outside interests and knowledge into the medical field

It’s not always easy, but if you can define what you most want out of medicine, you can find a way to make it happen. Dr. Kovarik knew she wanted to leverage telecommunications technology to benefit underserved global populations, and that she preferred working in a field that would be visual. Taken together, teledermatology was the perfect fit, and at the time it was only just beginning. It may seem obvious at face value, but deeply knowing what you want is crucial for making it happen.


2.) Teledermatology is not Skype, and is way different than just outsourcing diagnoses

Before doing research for our discussion, I had assumed that anything with a “tele” at the start meant you’d be Skype-chatting with a doctor. However, telemedicine is not the same thing as teledermatology, though they share some similarities. At the present, teledermatology centers around storing and transferring images to dermatologists who can make diagnoses and provide instructions for treatment from afar. The key thing is that with teledermatology, physicians are both diagnosing AND giving treatment instructions. Thus, it is critical that the dermatologist understands the community where the patient lives, the culture, and the treatments and medications available to them. When outsourcing radiology work, the output is usually just an impression. There is less liability, because no treatment plan is laid out, and the work must be double-checked. Thus, there are a unique set of problems that those in teledermatology must address in the coming years before it can grow.

3.) The barriers to the growth of teledermatology are not insurmountable, but will require policy changes and activism

Currently, the obstacles facing teledermatology include liability, reimbursement, and scaling. While some programs, like the Botswana UPenn-Partnership, negotiate directly with foreign governments to lay the ground rules for the relationship, it can be tricky. In the coming years, policy changes will be necessary, and passionate physicians will need to lead the charge, demonstrate the value of teledermatology, and justify reimbursement by showing the hard work they must put in to make it successful.


Check out this article for more info on Dr. Kovarik and her efforts to improve and spread teledermatology services across the U.S and the rest of the globe.


– Ryan is a first year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, the co-host of the Penn Health-X podcast, and founder/editor-in-chief of the Penn Health-X blog. You can contact him at ryan.o’ –

Dr. David Fajgenbaum: Lessons and Takeaways (Podcast #1)

Ryan O’Keefe, MS1

Penn Health-X had the pleasure of welcoming Dr. David Fajgenbaum MD, MBA, MSc to be our first seminar series speaker this semester. Dr. Fajgenbaum shared the story of his struggle with Castleman Disease, and establishing the Castleman Disease Collaborative Network (CDCN). He also shared some advice on becoming a physician leader. After his talk, we were lucky enough to interview him for the very first Penn Health-X Podcast, in which we delved into more detail. You can find the podcast here.

Check out the article recently published in the New York Times on Dr. Fajgenbaum and his work with the CDCN. On the podcast, we filled in some of the blanks in the narrative presented by the Times.

Also check out an article published on UPenn’s website about Dr. Fajgenbaum.

There were a few major takeaways we’d like to share here.

1. Having previous success running an organization certainly helps, but at the end of the day starting something great begins with an email

Dr. Fajgenbaum started National Students of AMF when he was still an undergraduate student at Georgetown. Dr. Fajgenbaum’s mother was found to have a brain tumor, and she sadly passed away shortly thereafter. In her memory, Dr. Fajgenbaum knew he wanted to start something using her initials – A.M.F – but didn’t yet know what that would be. He ultimately realized that there was a huge need for grief support for college students, and so he began the National Students of AMF, and watched as chapters opened up on campuses across the U.S. AMF, now an acronym for “Always Moving Forward”, is meant to help students through the process of grieving, and is still active and helping thousands.

Dr. Fajgenbaum agreed that having the experience of starting and growing a national organization later gave him the confidence to start the CDCN when he recognized there was a need in the research community. He mentioned that it definitely helps to have a series of small wins in your pocket to build up your confidence. But at the end of the day, starting the CDCN began with an email. And then another email. And then thousands more. Great organizations and accomplishments seem so stable, and we assume that only natural leaders who have innate knowledge of what they need to do can start them. We forget that most actually begin with just an idea, and a humble email.

2. Find your mentors, and then stand on their shoulders

Though Dr. Fajgenbaum was driven, intelligent, and desperate for solutions, guidance from mentors, and using some of their clout, was a necessity in establishing the CDCN. Dr. Fajgenbaum pointed to Dr. Arthur Rubenstein , and Dr. Fritz van Rhee  as two of his earliest mentors. When sending out the very first emails to physicians to invite them to be a part of the CDCN, he included both of their names. It was essentially the subtle email version of name-dropping. Even with the support and involvement of two prominent names in orphan disease research, he didn’t hear back from most of the people he reached out to. Imagine the response rate if he tried to do it all on his own. When it comes down to making your passion projects a reality, there’s no shame in flexing your network muscles and enlisting the help of those with prominence. In fact, doing so is what gives you the greatest chance of success.

3. Not everyone has access to a business education, but everyone has access to the internet and to books

If you want to be a physician leader in the H-MET space, or in any area of healthcare, you will need to learn some basic business skills. While Dr. Fajgenbaum opted to complete an MBA degree at Wharton, where he picked up some of these skills and was able to grow his network, not everyone has the opportunity to get an MBA, let alone at one of the best schools in the country. Yet, Dr. Fajgenbaum was adamant that if you identify the skills you need to practice, and have the drive, books may be all you need. Two skills that Dr. Fajgenbaum believe were critical to the success of the CDCN include knowing how to properly correspond with others (especially via email), and knowing how to negotiate.

Dr. Fajgenbaum mentioned the book Getting More: How You Can Negotiate to Succeed in Work and Life by Wharton professor Stuart Diamond, as one of his favorites. Those in medical school or interested in the sciences may believe that research and medicine are apolitical, and that everyone works together for a common good. I remember having those thoughts when I was in high school. I distinctly remember saying to myself “I want to go into a field that isn’t political – medicine.” That’s laughable and naive these days, but many laypeople and those early in their education – the bright-eyed and bushy tailed among us – still believe that this is how the research world works. Dr. Fajgnebaum mentioned that dealing with egos, differing interests, and money was something he was not nearly prepared to do. Understanding how to negotiate is critical. This includes creating win-win scenarios, and learning how to frame proposals in another person’s interest. If you haven’t yet read the classics, such as Dale Carnegie’s How to Win Friends and Influence People, or Robert Cialdini’s Influence: The Psychology of Persuasion  – why? There’s a reason they are timeless.

Beyond negotiations, when reaching out to physicians, Dr. Fajgenbaum always personalized the messages. Though this can be time consuming, especially when hundreds of emails need to go out, you improve the chances that someone will respond, no matter how busy they are. He mentioned that he would include references to their past research. It’s no surprise that people love discussing themselves and their accomplishments. Learning to stroke someone’s ego is not simply flattery, it’s a way to get someone to listen to you. You can have the best, most important idea out there, but if no one is listening, or replying to your emails, what good is it? You may think it boils down to “be a nice person”, but that’s the bare minimum!

Here are some great sources on how to get a reply from someone you’d like to speak with. It only took a few googles to find what I was looking for. That’s powerful.

Final Thoughts

You may be concerned that there isn’t enough time to read a few business books, or find the perfect mentors, or send the 300 emails to get your project off the ground. After all, they don’t test negotiations on STEP 1, and the coagulation cascade isn’t going to learn itself. Speaking with Dr. Fajgenbaum made one thing clear – you need to dig your well before you are thirsty. These skills may not seem entirely relevant, but when you have that great idea, or see an opportunity emerge, you want to make sure you have the resources and skills to go after what you want. Undoubtedly, starting anything is trial and error. But the more prepared you are, the less error.


– Ryan is a first year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, the co-host of the Penn Health-X podcast, and founder/editor-in-chief of the Penn Health-X blog. You can contact him at ryan.o’ –